Early moves in hospital can help keep Utah, nation's moms breast-feeding

By Michael Appelgate The Salt Lake Tribune

Published June 4, 2012 12:19 pm

Report shows "Baby Friendly" environment at hospitals can make a difference.

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Planning to exclusively breast-feed?

Start right after giving birth, feed on demand, keep the baby in your hospital room to sleep and ask the staff for support.

Such "Baby Friendly" steps make it more likely a new mom will stick to her breast-feeding goal, says a new report from the Centers for Disease Control and Prevention.

Published Monday in Pediatrics, the study found women struggle to breast-feed as long as they had intended. More than 1,200 mothers who aimed to exclusively breast-feed for three months or more were surveyed from 2005 to 2007.

More than 67 percent didn't make it. And 15 percent of those mothers gave up on their goal within a week of leaving the hospital.

Researchers examined whether it made a difference when mothers were exposed to the 10 practices recommended by the Baby Friendly Hospital Initiative, promoted by the World Health Organization and the United Nations Children's Fund.

Requirements for Baby Friendly status  held in Utah only by the University of Utah Hospital  include policies that encourage babies "rooming-in" with mothers and discourage using formula unless medically directed.

Mothers who experienced six of the recommended practices had 2.7 times the odds of achieving their goal, compared to women exposed to zero or one.

"One of the most important facts is keeping the baby and mother together," said Karen Buchi, the center's Well Baby Nursery co-medical director. "Most of our healthy babies never actually have to leave their mother's side."

Annette Clark, 33, gave birth Tuesday at University Hospital. She and her husband, Ken, are planning for their new daughter, Riley, to be breast-fed for at least six months.

"I'm going back to work [in 10 weeks], but the longer you can breast-feed is the goal," she said.

Nurses helped her start breast-feeding in the hour after Riley, her first child, was born and continually asked how it was going, Annette Clark said.

That support "is really important; the nurses here are fantastic," she said. "Without that, I'm not sure it would've been as easy to get started."

The first days of breast-feeding are the most trying time for mothers, Buchi said. In the past, when frustrations arose, formula was at hand.

It was provided free to parents and was sometimes given to calm a crying baby, she said. After baths, a bottle would be placed in a baby's bed "just in case they needed it," Buchi said.

Such "non-breast milk feedings" were the primary hospital practice associated with women not achieving their exclusive breast-feeding goal, the CDC said.

"Despite all of the mothers in this analysis intending to exclusively breast-feed, 40 percent reported that their infant received supplemental feedings in the hospital," the study said.

Delays before a mother begins to produce breast milk, less effective instruction from hospitals and perceived problems with breast-feeding during the hospital stay also contributed to women stopping sooner than they intended, the study said.

The American Academy of Pediatrics, which publishes Pediatrics, recommends mothers breast-feed exclusively for at least six months. Its studies show breast milk has all the essential nutrients, calories and fluids a baby needs to be healthy, including antibodies to help prevent infections. However, commercial infant formulas are a nutritious alternative, it notes.

What is most important, according to Buchi and the AAP, is feeding newborns in their first hours and days with their mother's colostrum, which forms late in pregnancy and appears before breast milk. It's high in protein and low in fat.

While more than 80 percent of Utah mothers breast-feed at least once, the CDC reports that 21.8 percent of the state's infants receive formula within two days of being born.

Buchi said medical center staff do not require parents to breast-feed exclusively but provide facts and support for those who choose to do so.

Doctors promote breast milk for the long-term health of infants, Buchi said. Still, formula sometimes must be provided to babies for medical reasons. And it is "good food," she said, noting every parent's situation is different.

"You just provide information and let them make the choice," Buchi said. "Children still thrive being formula fed."

As they left the hospital Thursday, the Clarks said they felt well-prepared. But they're not sure what struggles they'll face, or whether they'll need to use formula when Annette returns to her job at the U.

"We see breast-feeding as the best option," said Ken, 37, who works at Rocky Mountain Power. "But we don't know what it's going to be like. We have a plan, but it could definitely veer off." 

Becoming 'Baby Friendly'

The 10 steps for "Baby Friendly Hospitals," outlined by the World Health Organization and the United Nations Children's Fund:

• Write a breast-feeding policy; educate all health care staff.

• Train staff in skills needed to implement it.

• Tell all pregnant women about the benefits and management of breast-feeding.

• In Utah, 44 percent of mothers exclusively breast-feed for three months, and 17 percent continue for six months, ranking Utah slightly above average nationwide.

• However, Utah ranks near the top in mothers having ever breast-fed, at 84.5 percent.

Source: Centers for Disease Control and Prevention 

Breast-feeding benefits

• Breast milk has all the nutrients, calories and fluids a baby needs for healthy growth.

• It contains antibodies to help prevent ear infections, and other bacterial and viral infections, such as meningitis.

• For the mother, breast-feeding reduces her chances of breast and ovarian cancers.

Source • American Academy of Pediatrics

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